Provider First Line Business Practice Location Address:
6317 WILSHIRE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90048-5602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-653-6080
Provider Business Practice Location Address Fax Number:
323-653-2503
Provider Enumeration Date:
11/03/2005